American Academy of Pediatrics

The American Academy of Pediatrics (AAP) is an American professional association of pediatricians, headquartered in Itasca, Illinois. It maintains its Department of Federal Affairs office in Washington, D.C.

Background

The Academy was founded in 1930 by 35 pediatricians to address pediatric healthcare standards. It has 67,000 members in primary care and sub-specialist areas. Qualified pediatricians can become fellows (FAAP).

The Academy runs continuing medical education (CME) programs for pediatricians and sub-specialists. The Academy is divided into 14 departments and 26 divisions that assist with carrying out its mission.

Publications

It has the largest pediatric publishing program in the world, with more than 300 titles for consumers and over 500 titles for physicians and other healthcare professionals. These publications include electronic products, professional references/textbooks, practice management publications, patient education materials, and parenting books.

The ''AAP News'' is the academy's official news magazine, and '' Pediatrics'' is its flagship journal.

The AAP issues a weekly report on COVID-19 cases in the United States. States began reporting COVID-19 cases on September 17, 2020. The AAP tracked 587,948 child COVID-19 cases, 5,016 child hospitalizations, and 109 child deaths.

The Julius B. Richmond Center

In 2006, the Academy received a grant from the Flight Attendant Medical Research Institute (FAMRI) to plan and establish a Center of Excellence dedicated to the elimination of children's exposure to tobacco and secondhand smoke. The Richmond Center was established to help institutionalize pediatric tobacco control activities at AAP and was named in honor of Julius B. Richmond, MD, Chair of the FAMRI Medical Advisory Board and former Surgeon General of the United States Public Health Service. The Center provides the education, training, and tools needed to effectively intervene to protect children from the harmful effects of tobacco and secondhand smoke.

Policy positions

The Academy has published hundreds of policy statements ranging from advocacy issues to practice recommendations. The academy's policy website contains all current Academy policies and clinical reports. The AAP policy regarding its statements is to give each statement a five-year life, after which the statement expires unless it is reaffirmed.

Age limit

The AAP has changed positions on its age limit throughout the years. In 1988, the American Academy of Pediatrics published a statement on the age limit of pediatrics that identified the upper age limit of pediatrics as age 21. The policy had a note that exceptions could always be made when the doctor and family jointly agree to an older age.

Recent studies have shown that the age of 21 years is just an arbitrary line for adolescence because brain development has not reached adult levels of functioning until their early 30s. In a 2017 policy update, AAP changed its policy to discourage age limits of pediatric providers and instead have families reach an agreement with their pediatric provider as to when to transition care.

Asthma

In 2009, the national office and four of its State chapters provided training support to 49 pediatric practices to improve adherence to well-established asthma care guidelines. The percentage of patients at participating practices with well-controlled asthma (as defined by the National Heart, Lung, and Blood Institute) rose from 58 to 72 percent.

Car safety seats

The AAP periodically issues guidance for child passenger safety, including policy recommendations for transitioning between rear-facing car seats, front-facing car seats, belt-positioning booster car seats, and vehicle safety belts. These recommendations are typically published in the peer-reviewed scientific journal Pediatrics, and tend to attract attention and controversy in popular press and social media.

Previously, the AAP recommended that children remain rear-facing until they are two years of age. In response to updated crash test, simulation, and field data, the AAP revised their guidance to exclude the age guideline entirely. Current AAP Child Passenger Safety recommendations (as of August 30, 2018) state that children should remain in a rear-facing car seat for as long as possible, until they meet the maximum height or weight dictated by the car seat manufacturer. The full recommendations state that:

# Infants, toddlers and children should remain rear-facing as long as possible. Currently available car seats provide weight and height limits that allow children to be rear-facing beyond their second birthday.
# Once children are transitioned to forward-facing, they should use a car safety seat equipped with a 5-point harness for as long as the manufacturer recommends (i.e., until they reach the manufacturer's weight or height limit). Currently available convertible car seats and combination car seats support the use of a 5-point harness until a child is or more.
# Once children are transitioned to a belt-positioning booster car seat, they should continue to use the booster until the vehicle's lap and shoulder belt fit properly, which typically occurs when a child is over tall, and approximately 8–12 years of age.
# Once children are transitioned to the vehicle's lap and shoulder seat belt, they should always use the vehicle's seat belt to maximize protection in the event of an accident.
# Children under 13 years of age should be seated in the rear passenger seat (not the front seat) to maximize protection in the event of an accident.

COVID schooling in person

On June 29, 2020, AAP stated that it "strongly advocates that all policy considerations for the coming school year should start with a goal of having students physically present in school" as remote learning makes it more difficult for education professionals to notice learning deficits, physical and sexual abuse, depression and suicidal ideation. The AAP argued that masks are probably not practical for children younger than middle school unless they can wear a mask without increased face touching. Teachers unions opposed the AAP statement, however, saying "Our educators are overwhelmingly not comfortable returning to schools ... They fear for their lives, the lives of their students and the lives of their families." Two weeks later, the AAP walked back its support, under political pressure from teachers and other groups. President Donald Trump had cited AAP's original statement repeatedly, pressuring school leaders to reopen schools.

Digital advertising to children

In its 2020 statement in ''Pediatrics'', the AAP called for banning all digital advertising targeted to children under the age of 7 and urged limits to advertising aimed at people under 17.

Elective infant circumcision

In 1999, the academy said that the health benefits of the procedure outweigh the risks, and supports having the procedure covered by insurance.

In a 2012 position statement, the academy stated that a systematic evaluation of the medical literature shows that the "preventive health benefits of elective circumcision of male newborns outweigh the risks of the procedure" and that the health benefits "are sufficient to justify access to this procedure for families choosing it and to warrant third-party payment for circumcision of male newborns," but "are not great enough to recommend routine circumcision for all male newborns". The academy takes the position that parents should make the final decision about circumcision after appropriate information is gathered about the risks and benefits of the procedure.

After the release of the position statement, a debate appeared in the journal ''Pediatrics'' and the ''Journal of Medical Ethics''. In 2013, a group of 38 Northern European pediatricians, doctors, surgeons, ethicists and lawyers co-authored a comment stating that they found the AAP's technical report and policy statement suffered from cultural bias, and reached recommendations and conclusions different from those of physicians in other parts of the world; in particular, the group advocated instead a policy of no-harm towards the infants and respect for their rights of bodily integrity and age of consent. An opinion by two authors stated that, in their view, the AAP's analysis was inaccurate, improper and incomplete. The AAP received further criticism from activist groups that oppose circumcision. The AAP responded to these criticisms in the ''Journal of Medical Ethics'', calling for respectful and evidence-based debate.

The AAP policy regarding its statements is to give each statement a five-year life, after which the statement expires unless it is reaffirmed. The 2012 Circumcision Policy Statement has not been reaffirmed, so it expired in 2017. As of 2021, the AAP has no official circumcision policy.

Electronic Nicotine Delivery Systems

Electronic nicotine delivery systems (electronic cigarettes, e-hookahs, vape pens, others) are highly addictive and often candy flavored products that are rapidly rising in popularity among middle and high school students, and appear to be serving as a gateway to other forms of tobacco, and threaten to addict a new generation to nicotine. 

When they are sold, concentrated nicotine solutions such as those used in electronic nicotine delivery systems should be required to be in child-proof containers and be limited to a quantity of nicotine that would not be lethal to a young child if ingested.  The US Food and Drug Administration needs to tightly regulate these products to protect youth.

Female genital cutting

In April 2010, the academy revised its policy statement on female genital cutting, with one part of the new policy proving controversial. Although condemning female genital cutting overall, this statement suggested that current federal law banning the practice had the unintended consequence of driving families to perform the procedures in other countries, where these girls faced increased risk. As a possible compromise, this policy statement suggested that physicians have the option to perform a ceremonial "nick" on girls as a last resort to prevent them from being sent overseas for full circumcision. This particular position proved controversial to advocates for a full ban on female genital cutting under any circumstances and concern from other medical groups that even a "nick" would be condoning this widely rejected procedure. One month later, the academy retracted this policy statement.

Genetic testing in children

The American Academy of Pediatrics AGCM posted guidelines in dealing with the ethical issues in pediatric genetic testing.

Gun violence prevention

The American Academy of Pediatrics says that although U.S. firearms-related deaths have dropped since the 1990s, guns were responsible for over 80 percent of teen homicides in 2009 and were the most common suicide method among teens. The AAP believes pediatricians should discuss guns and gun safety with parents before babies are born and at children's annual exams. It also advocates for, among other things, more background checks, an assault weapons ban, and federal research on gun violence.

Marijuana

The AAP warns of possible marijuana damage to children and adolescents. In states that have already legalized marijuana, the Academy recommends that pediatricians and regulators treat it as they would with tobacco. The Academy does support "decriminalization" of marijuana—reductions in the penalties for its use and possession—in combination with an increased commitment to substance-abuse treatment. The Academy also recommends changing marijuana from a DEA Schedule 1 to a DEA Schedule 2 to facilitate research into pharmaceutical uses.

School start times for adolescents

Recognizing that insufficient sleep in adolescents is an important public health issue that significantly affects the health and safety, as well as academic success, the American Academy of Pediatrics strongly supports efforts of school districts to optimize sleep in students and urges high schools and middle schools to aim for start times no earlier than 8:30 a.m. to allow students the opportunity to achieve optimal levels of sleep (8.5–9.5 hours) and to improve physical and mental health, safety, academic performance, and quality of life. Although the AAP acknowledges that numerous factors may impair the amount and/or quality of sleep in adolescents—among them, biological changes in sleep associated with puberty, lifestyle choices, and academic demands—it considers school start times before 8:30 a.m. ("earlier school start times") to be a key modifiable contributor to insufficient sleep, together with circadian rhythm disruption. It also recognizes that a substantial body of research has demonstrated that delaying the start of the school day is an effective countermeasure to chronic sleep loss and has a wide range of potential benefits to the physical and mental health, safety, and academic achievement of students—including reduced obesity risk, rates of depression, and drowsy driving crashes as well as improved academic performance and quality of life. Later start times also result in less frequent tardiness.

Abusive head trauma

There is limited medical controversy surrounded the AAP regarding "abusive head trauma". The current skepticism is not whether violent shaking, or shaking with slamming, is dangerous to infants or children, but of how the scientific information is used in the legal processes. The AAP updated its policy paper in 2020. In the updated policy paper, the APP states "The AAP continues to affirm the dangers and harms of shaking infants, continues to embrace the 'shaken baby syndrome' diagnosis as a valid subset of the AHT diagnosis, and encourages pediatric practitioners to educate community stakeholders when necessary."

Statins for high cholesterol in children

AAP and the American Heart Association recommended statins for children as young as eight years with high lipid concentrations and for children as young as two years with major cardiovascular risk factors. The AAP was criticized for "fear that it will open the way for drug companies to bombard anxious parents with ads promoting these and other products and increase the number of parents insisting on prescriptions for their children. The ease of popping pills should not distract parents, health professionals, or policy makers from the more arduous tasks of cutting back on junk foods, promoting healthy diets, and putting physical education back into the schools."

Tobacco

AAP recommends that tobacco control programs should change the image of tobacco by telling the truth about the substance.  This includes prohibiting tobacco advertising and promotion that is accessible to children, as well as point of sale advertising, product placements in movies and other entertainment media, and promotion in print or internet based media accessible to youth.  Advertising and promotion has been shown to be a cause of tobacco use initiation in adolescents.

AAP supports a minimum purchasing age of 21 years for tobacco products. Increasing age of purchase has been shown to decrease youth smoking rates.  Younger age of starting tobacco use leads to lower the rates of ever stopping tobacco use.

In addition to comprehensive smoking bans in workplaces and public areas, smoking in multi-unit housing should be prohibited

Transgender children

In 2018, the AAP issued a policy statement putting forward a model of "gender affirmative care". Gender affirmative care is based in the idea that "transgender identities and diverse gender expressions do not constitute a mental disorder", that "variations in gender identity and expression are normal aspects of human diversity, and binary definitions of gender do not always reflect emerging gender identities", that "gender identity evolves as an interplay of biology, development, socialization, and culture" and that "if a mental health issue exists, it most often stems from stigma and negative experiences rather than being intrinsic to the child". The AAP also describe in this policy "conversion" or "reparative" therapy as "unsuccessful", "deleterious" and "outside the mainstream of traditional medical practice". Finally, the AAP recommends that youth identifying as transgender have access to comprehensive and development-appropriate healthcare provided in safe and inclusive clinics but also that family based therapy be available. The AAP also recommend that the medical field and federal government prioritize research that is dedicated to improving the quality of evidence-based care for transgender youth.

In early 2022, five AAP members proposed Resolution 27, which called for a review on the evidence for transgender youth healthcare and called for an update to the AAP's 2018 policy statement on gender affirmative care. The resolution was proposed again in August 2022 but failed to pass. The physicians who proposed Resolution 27 claimed that they were being sidelined and that the AAP changed its processes to block discussion of the resolution. In response, the AAP said that its process worked as it should have and that Resolution 27 did not pass because the majority of AAP members did not agree with the resolution. One of the authors of Resolution 27 works with Genspect, a gender critical organisation.

In July 2022, Genspect asked the AAP for a "non-partisan and systematic review of evidence" to support gender affirmative care, adding that "Many of our children have received this care and are anything but thriving." The AAP said it is updating its statement "Providing affirmative clinical care", adding that "Robust evidence demonstrates that access to gender-affirming care decreases risk of suicidal ideations, improves mental health, and improves the overall health and well-being of transgender and gender-diverse youth."

Programs

Brush, Book, Bed

Brush, Book, Bed (BBB) is an American Academy of Pediatrics program aimed at improving children's health by creating a nighttime routine of brushing the child's teeth, reading together, and setting a bedtime. It was developed to help pediatricians communicate a simple message to families.

See also

* American College of Pediatricians
* American Pediatric Society
* Academic Pediatric Association
* Society for Pediatric Research
* Sheppard–Towner Act

References

External links

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1930 establishments in Illinois
Elk Grove Village, Illinois
Medical associations based in the United States
Medical and health organizations based in Illinois
Organizations established in 1930
United States
Pediatric organizations